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Thread: NHS provokes fury with indefinite surgery ban for smokers and obese

  1. #26
    Registered: Apr 2003
    Location: Wales
    I'm not so sure about that. I believe that a majority would prefer to see the NHS well funded. But I also think a majority believe there's a lot of wastage of resources and possibly/probably would like to see funds go to what they believe are medical necessities rather than what they see as medical choices without understanding the cost of mental health issues resulting from not being able to get IVF or sex change treatment, psychological help etc. etc.

    My biases tend towards thinking Tories are of the 'be a man, pull your socks up and stop snivelling' thinking.

    Edit. That is just my opinion but I have seen tremendous improvement in service since I first started seeing a doctor on my own and I do believe that the doom and gloom merchants have the loudest voice.

  2. #27
    Still Subjective
    Registered: Dec 1999
    Location: Idiocy will never die
    Quote Originally Posted by heywood View Post
    Regardless of the headline, I can't see this as anything other than punitive.

    The proposed rules mean that people are going to be denied treatment for reasons that may be completely unrelated to their ailment, which is just plain unfair and discriminatory.
    Look at it this way - if an obese person has a bad knee because they are obese, and the knee replacement is more likely to fail because they are obese and smoke, it ends up costing much more money to fix this knee problem than it would in a non-obese, non-smoker.

    Let's make up some figures - in potatoes P.

    It costs P100 to do a knee op. In an obese smoker it lasts on average 5 years before it needs a redo. In everyone else it lasts 10 years.

    For every obese smoker over 10 years you've just denied a knee op for someone who took care of themselves. So not only are they costing more money, they are affecting other people's care AND they chose to do this.

    So this isn't 'completely unrelated to their ailment', is it? And to top it off it makes life harder for other people. Do those maths over 20 years. That's a lot of suffering because someone else had poor self control.

    Now this isn't my opinion, but that is the argument and when you've got limited funds if you want to be 100% utilitarian/pragmatic it makes perfect cold, logical sense.

  3. #28
    Registered: Sep 2001
    Location: Qantas
    Like I said, if the patient's condition makes surgery risky or of limited or temporary benefit, that should be factored into the decision whether or when to operate on a case by case basis. And it shouldn't matter whether the patient's condition is a result of smoking, obesity, alcoholism, cancer, a birth defect, sports injuries, or something else. In some cases, you may put a patient in the back of the queue for surgery because of a health condition that makes them a poor candidate for surgery, and the health condition resulted from smoking or obesity. But in many other cases, there won't be any direct relationship between the person's smoking or obesity and the ailment they need surgery for. If you deny surgery to a demographic group categorically, without fair consideration of the risks and benefits in each case like you would for everyone else, that's just plain old discrimination. And pretty mean spirited too.

  4. #29
    Registered: May 2004
    But the demographic group is characterised by bringing more risk to the (operating) table. It's not like smokers and obese people were picked arbitrarily. Smoking and obesity itself are risk factors that lead to worse outcomes. Also, they would not be denied surgery outright. It's not even as if people would be asked to quit smoking -- they could simply wear nicotine patches for 8 weeks before the surgery to reduce the risks. It would not be a blanket restriction on all non-urgent surgeries either.

    Also, apparently a large percentage of people who supported this would be directly affected by the proposal and would likely have to pause their smoking or lose weight for some types of surgery.

    There is a significant level of public support for most of the changes that have been agreed – even from people who told us that they would be directly affected by the policy changes that we proposed. Our fitness for surgery proposal is a good example of this – 84% of those who responded thought this would mean that they themselves would need to either stop smoking or lose weight if they needed a non-urgent operation, but agreed with this policy.
    Last edited by Starker; 25th Oct 2017 at 05:47.

  5. #30
    Registered: Sep 2001
    Location: Qantas
    The risk argument also applies to old people, people with heart disease, kidney disease, liver disease, cancer, asthma, diabetes, people with weak immune systems, drug abusers, and a whole host of other things. Probably the majority of people considering surgery have some risk factor. COPD is risk factor and smoking is common cause of COPD. If a doctor decides that a person with an advanced COPD is a bad candidate for surgery because of the risk, that's just prudent medicine, regardless of whether the COPD was caused by smoking or something else. But if a smoker can't get surgery even though they don't have COPD, heart disease, or any other adverse condition caused by their smoking, that's discrimination.

    We can spend all day cherry picking examples where denying surgery to a smoker or obese person is justifiable or not justifiable, but that just reinforces my point that you have to consider every patient's situation on its own merits, give every patient equal consideration.

    Among all the risk factors, only smoking and obesity were singled out, because their low social status makes them convenient scapegoats.

  6. #31
    Registered: May 2004
    Quote Originally Posted by heywood View Post
    But if a smoker can't get surgery even though they don't have COPD, heart disease, or any other adverse condition caused by their smoking, that's discrimination.
    But they could get surgery, though? They would just have to wear a nicotine patch for 8 weeks. And they'd have less risk of complications and dying.

  7. #32
    Registered: Sep 2001
    Location: Qantas
    What makes you think that wearing a nicotine patch for 8 weeks is going to reduce their risk of complications and dying? If they have an adverse health condition that's due to smoking, it's not going to clear up in 8 weeks. Smoking related diseases are chronic and mostly irreversible. And if they don't have any adverse health condition that would affect surgery, why put it off?

    By the way, where did you find 8 weeks? As far as I could tell the details of the policy (e.g. what it meant to 'quit smoking') were still being worked out.

  8. #33
    Registered: May 2004
    Because smoking is a direct risk?

    I don't know if 8 weeks is exactly what was proposed in Hertfordshire this time, but I think I read it in an article I can't find right now. Also, it's what they reccommend here:

    People who give up at least 8 weeks before their operation reduce their risk of breathing complications to the same level as people who never smoked. But even if you have a few days or weeks before your operation, giving up will still be beneficial.
    And again here:

    Referral should be considered when other pre-existing medical conditions have been optimised, and there has been evidence of weight reduction to an appropriate weight. Patients who are overweight (BMI 25 – 29.9) or obese (BMI >30) should be encouraged and supported to reduce their BMI below 25. Equally, patients who smoke should be encouraged to stop smoking at least 8 weeks before surgery to reduce the risk of anaesthestic or operative complications.
    Last edited by Starker; 25th Oct 2017 at 10:59.

  9. #34
    Registered: Apr 2011
    Its not an unusual tactic for tyranny minded bully types who like to push their agendas on people to use public resources to push their agendas.

    Thats why I believe in separate but equal.
    Thats why we should SEPARATE our personal lifestyles, resources, responsibilities and the bills for it so that some people cant use a shared bill to pick fights about what we're all allowed to do according to who.

    Example, when purchasing car insurance teenagers have to pay more.
    Or health insurance, smokers have to pay more.

    Now shouldn't that be the same for anybody with a high risk lifestyle choice.
    Maybe you like to sky dive, or disco dance with a high risk crowd of people.

    But some people want to use the high costs of things to tell you what YOU cant do,
    and how we should all chip in to pay the high cost of what THEY want to do.

    And the do the same thing with taxes.
    They spend all day dreaming up ways how anything that they dont like should be taxed,
    and how anything they like is their "right" to be paid for by "all of us".

    Separate but equal would keep it nice and clear who's paying for what,
    in a culture of diversity who have to live together,
    but might not have much in common.

    And then we wouldn't have to fight about it.
    Last edited by robthom; 12th Nov 2017 at 21:13.

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